Patellar Fracture After ACL Reconstruction: Open Reduction and Internal Fixation with a Maxillofacial Plate: A Case Report

Minimally Invasive Harvesting of Triple-Fold Superficial Layer Quadriceps Autograft for Knee Ligament Reconstruction

Graft selection plays a critical role in anterior cruciate ligament reconstruction. Autograft options, including hamstrings, bone-patellar tendon-bone, and quadriceps, offer distinct advantages and disadvantages. Soft tissue quadriceps tendon autografts are increasingly favored due to their strength, size compatibility, and potential for enhanced graft healing. This technique offers minimal skin incision, a longer graft, and reduced morbidity, as it specifically targets the superficial band of the quadriceps tendon.

A simple way to deal with an inadvertently cut suture while inserting the screw in the tibial tunnel during ACL reconstruction

Introduction

There are many complications that can occur during or after ACL reconstruction, including a suture inadvertently cut by the screw threads while inserting the interference screw in the tibial tunnel. No fixes for this small but annoying problem have been proposed to date in the literature, and herein we propose a simple way to deal with this situation by bringing the tibial side of the ACL graft through the anterolateral portal and re-suturing with a stronger suture material.

Case presentation

A 48-year-old Thai female was undergoing an ACL reconstruction with a hamstring graft following a standard technique when the holding suture and distal part of the ACL graft were accidentally cut by the screw. Rather than redoing the graft from the beginning, we did a workaround by bringing the tibial end of the graft through the AL portal and re-suturing.

Discussion

In ACL graft fixation, when inserting the interference screw into the tibial tunnel there is a risk of cutting the holding suture with the screw. When this happened in our situation, we decided to attempt to redo the suture by first taking the graft out through the AL portal and then re-suturing with a stronger suture material.

Conclusion

If inadvertently cutting the holding suture while inserting the screw in the tibial tunnel during ACL reconstruction occurs, the surgeon can use the simple solution we applied in this case to solve this problem or to avoid having to redo the entire procedure.

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During tibial fixation the holding suture has a chance of being inadvertently cut by the thread of the interference screw.

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The tibial side of the ACL graft can be re-sutured by bringing it through the anterolateral portal.

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To prevent cut suture during interference screw fixation on the tibial side, the surgeon should use a stronger suture material to reduce the risk

Management of Patella Fracture Nonunion and Large Bone Defect After Bone-Patellar Tendon-Bone Autograft: A Case Report

CASE

A 32-year-old patient was diagnosed with a vertical patella fracture nonunion after a bone-patellar tendon-bone (BTB) anterior cruciate ligament reconstruction. In addition, a 1 × 2 × 1 cm patellar bone defect was noticed at the graft harvesting site. The patient was treated surgically with open reduction and internal fixation and iliac crest bone autograft which resulted in fracture union.

CONCLUSION

Many intraoperative and postoperative risk factors for iatrogenic patella fracture when harvesting BTB autograft were identified. Surgeons should be aware of technical skills needed to prevent this complication and should treat the fracture appropriately to avoid nonunion and optimize the outcome.